Thursday, June 29, 2006

Medicine: Counseling better than Lunesta for insomnia in old folks

As reported in the Journal of the American Medical Association, the researchers assessed sleepooutcomes in 46 insomnia patients, at least 55 years of age, who were randomly assigned to CBT, zopiclone or a placebo. The subjects were treated for 6 weeks and were followed for up to 6 months.

The features of CBT, which was conducted in weekly 50-minute sessions, included education about lifestyle factors that influence sleep, such as the importance of maintaining a strict sleep schedule and using the bedroom only when sleepy. The subjects were also taught to recognize and correct sleep misconceptions and how to perform progressive relaxation techniques.

After CBT, the percentage of time in bed actually spent sleeping, also referred to as sleep efficiency, increased from 81.4 percent at the beginning of the study to 90.1 percent at 6-month follow-up. By contrast, with zopiclone treatment, sleep efficiency actually worsened slightly, dropping from 82.3 percent to 81.9 percent.
As I've NEVER seen Lunesta prescribed, and only rarely see Ambien or Sonata being offered over trazodone, seroquel, or even benadryl, I thought I'd try to figure out why. Turns out Lunesta is just the S-enantiomer of zoplicone, and Wikipedia supplies me with all of the anti-corporate info I need to feel satisfied:
Zopiclone, as traditionally sold worldwide, is a racemic mixture of two stereoisomers, only one of which is active. In 2005, the pharmaceutical company Sepracor began marketing the active stereoisomer eszopiclone under the name Lunesta in the United States. This had the consequence of placing what is a generic drug in most of the world under patent control in the United States. Apart from the difference in dosage (eszopiclone dosages are exactly one-half that of equivalent Zopiclone dosages), the two drugs are identical in effect.
Smells like Lexapro with its statistically insignificant advantages over Celexa.

And the last line of the article is even more interesting:
They also suggest that future studies should try to identify the factors in the CBT regimen that produce the best results and if CBT sessions need to be repeated to maintain the improvements.
Engineering more exact CBT for particular problems would be a medical economist's wet dream, and a drug company's dry nightmare. Which is why, of course, that research won't actually be done any time soon.


: Joseph j7uy5 said...

Lunesta is very popular in the community. I can't tell you how many people have asked me about "the little butterfly."

The problem with promoting CBT is threefold. Pharmaceutical companies have no interest, obviously; insurance companies are inherently skeptical of psychotherapy of any sort, and do not want to encourage it; and, you can't get tenure publishing papers on psychotherapy. I guess you could add that you can't get big federal research grants for a study of psychotherapy.

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